Israel journal of medical sciences
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An off-line system for automating the problem-oriented record implemented at Kibbutz Shuval is described. The Shuval problem-oriented record consists of acute and chronic problem lists, a preprinted data base collected by patients and nurses, problem-oriented plan flow sheets, problem-oriented progress notes and a regular record audit. The mean conversion time from a traditional record to a problem-oriented record was 17 min for a child's record and 25 min for an adult's. ⋯ Transfer of data took, on the average, 10 min (range, 5 to 30 min) for a child's record. The following five types of analysis can be performed with the Shuval automated problem-oriented record: administrative, patient care, epidemiologic, demographic and clinical research. Coupled with the manual problem-oriented record, the Shuval automated record provides many advantages of an on-line problem-oriented record at considerably less cost.
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Comparative Study
Differences in the use of emergency room and hospitalization in relation to primary care pediatric services.
Two pediatric primary care services in Ofakim, Israel, were compared with respect to their use of hospital emergency room facilities and hospitalizations. The services compared were a community-based university pediatric clinic in which preventive and curative care were merged and a traditional service in which preventive and curative care were provided by different agencies. ⋯ The proportion of children who were admitted to hospital, among those referred to the emergency room, was much higher for the university clinic. Consistent differences were not found in the number of hospital admissions/1,000 children in the population, nor in the mean duration of stay of hospitalized children.
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Ultrasound and other modalities were used to evaluate lateral masses in the neck in 26 patients. Accurate diagnosis of solid and fluid-filled masses, both with and without pulsatile components, was achieved through ultrasound studies. Computed tomography was particularly helpful in cases with bone involvement.
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Splenic rupture is the most frequent intraabdominal injury following blunt abdominal trauma. Massive hemorrhage commonly occurs from injuries to this friable vascular organ. The mortality rate from simple splenic rupture is 1%. ⋯ Fifteen patients were operated on more than 48 h after sustaining the injury. A detailed analysis of these 15 patients revealed that in only three did the evidence support delayed hemorrhage following traumatic rupture of the spleen. In the other 12 patients, there was a delay in recognition of the intraabdominal injury, almost entirely the result of "diagnostic error." Careful clinical inquiry and peritoneal lavage are the mainstays of early diagnosis and therapy and should help to eliminate any delay in the diagnosis of a ruptured spleen.
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The prevalence and causes of anemia were studied in 294 Druze children aged 10 months to six years. The hemoglobin level was less than 11.0 g/dl in 19%; none of these anemic children had folate deficiency. ⋯ Mean corpuscular hemoglobin and transferrin saturation were abnormal in greater than 90% of anemic children, whereas serum ferritin and total-iron-binding capacity were abnormal in only 70%. In view of its limited sensitivity, serum ferritin appears to be a less useful diagnostic aid in iron-deficiency anemia than other, less expensive laboratory methods.